Iran Heritage Foundation

IRAN HERITAGE FOUNDATION

NOROUZ 2006 CELEBRATION

Gala Dinner - Registration (Printer Friendly Form)

Tickets are non-refundable

Single tickets

_____ tickets @ 160 GBP each (ages 30 and above)

_____ tickets @ 100 GBP each for ages below 30

Donation

I have the pleasure of enclosing a donation of GBP

TOTAL

Payment for the amount shown above

____ Enclosed please find cheque (made out to the IRAN HERITAGE FOUNDATION)

____ Debit my credit card (Visa, Mastercard & Amex only)

_____ VISA _____ Mastercard _____ AMEX
Cardnumber	_______________________________________________
Expiry date	_______________________________________________
Name	Title_____First____________Last ___________________
Address	_______________________________________________
City	_______________________________________________
County/State	_______________________________________________
Post/Zip Code	_______________________________________________
Country	_______________________________________________
Signature	_______________________________________________
Name and address where tickets should be mailed to
Name	Title_____First____________Last ___________________
Address	_______________________________________________
City	_______________________________________________
County/State	_______________________________________________
Post/Zip Code	_______________________________________________
Country	_______________________________________________
Tel	_______________________________________________
Fax	_______________________________________________
E-mail	_______________________________________________

Name of person(s) for whom ticket(s) are purchased with this form. Please indicate age(s) of ticket holder(s) if under 30

Names

Tables seat either 10, 11 or 12. If you have not reserved a full table please mention with whom you would like to be seated

Names

Please print out this form and mail it after completing it with cheque drawn on a UK bank, banker's draft in UK sterling or credit card details to: Norouz Gala, Iran Heritage Foundation, 5 Stanhope Gate, London W1K 1AH.